Retroperitoneal hemorrhage

　　Retroperitoneal hemorrhage can occur suddenly, such as arterial hemorrhage, which can form a hematoma to compress the retroperitoneal tissue, spread between the mesentery, enter the retroperitoneal space behind the pelvis, or enter the peritoneal cavity. If the hemorrhage occurs slowly or stops spontaneously, it can be absorbed. If the blood remains in the retroperitoneum, it can occur organization to form a fibrous mass, even calcification. Blood contains nutrients, so the risk of infection is very high.

　　Retroperitoneal hemorrhage is common in complex abdominal injuries, accounting for 2/3 of retroperitoneal hemorrhage. It mainly includes:

　　1, Blunt trauma:Rupture and injury of retroperitoneal space with liver, spleen, kidney, adrenal gland, pancreas duodenum and its blood vessels; pelvic fracture with injury to rectum, bladder, and ureter; abdominal contusion, pelvic fracture, directly or indirectly damaging the retroperitoneal blood vessels and their branches.

　　2, Penetrating trauma:Penetrating injuries caused by bullets or shrapnel; stab wounds caused by a knife or sharp object; penetrating injuries to bone fragments after fractures. Retroperitoneal hemorrhage can also be seen in pathological destruction and hemorrhage of retroperitoneal organs, including: a, hemorrhagic necrotizing pancreatitis; b, hemorrhagic diseases, such as hemophilia, leukemia, hyperfunction of the spleen, etc., caused by various reasons, can lead to peritoneal hemorrhage due to low coagulation function; c, low coagulation function caused by anticoagulant therapy; d, caused by surgery in the retroperitoneal area; e, others: there are retroperitoneal tumors, hemangiomas, nodular polyarteritis, and spontaneous rupture of retroperitoneal blood vessels (abdominal stroke) and other diseases.

　　Since the retroperitoneal space is a loose tissue, the onset of hemorrhage is usually sudden, and the hematoma quickly spreads widely to form a large hematoma. The systemic response may include blood pressure drop, even shock. The retroperitoneal tissue is compressed, and the hematoma can spread along the posterior abdominal wall and between the mesentery, or it can break into the peritoneal cavity. If the hemorrhage occurs slowly or stops spontaneously, it can form a encapsulated or localized hematoma, and finally, the center may liquefy or fibrosis, organization, and smaller hematomas can be absorbed.

　　Complications include paralytic ileus, hemorrhagic shock, lower limb thrombophlebitis, and acute renal failure.

　　Paralytic ileus, also known as adynamic ileus, is caused by various reasons affecting the balance of the autonomic nervous system of the intestines; or affecting the local nerve conduction of the intestines; or affecting the contraction of intestinal smooth muscles, causing the intestines to dilate and the peristalsis to disappear. Patients have significant abdominal distension, without spastic colic, and the peristalsis is weakened or disappears, rarely causing intestinal perforation.

　　Hemorrhagic shock is a rare disease, most children have prodromal fever, upper respiratory symptoms, vomiting, and diarrhea. The main clinical features are acute encephalopathy (manifested as seizures, coma, and decreased muscle tone) and severe shock. Other common clinical features include high fever (up to 43.9°C, rectal temperature), disseminated intravascular coagulation, cerebral edema, hematochezia, metabolic acidosis, elevated liver transaminases, acute renal failure, thrombocytopenia, and decreased hematocrit. Primary involvement of the lungs and myocardium is rare.

　　The main symptoms are abdominal pain, which is the earliest and most common symptom, with varying degrees of severity, which can be localized or diffused, located in the abdomen, lateral abdomen, waist, even back or hip sacral region. Sometimes squatting can alleviate it. Other common symptoms include nausea and vomiting, constipation or mild diarrhea, decreased borborygmi, abdominal distension, and paralytic ileus. Severe cases may be accompanied by hemorrhagic shock and severe anemia. Hemorrhage and stimulation of the retroperitoneal nerves can cause sweating, palpitations, hypotension, syncope, even shock. Some patients may have a short-term fever. With the progression of the disease, paralytic ileus may occur. When the hematoma compresses the mesenteric blood vessels, local intestinal loop necrosis may occur. When the hematoma compresses the nerves, lower limb neurological pain, numbness, and even dysfunction may occur. The hematoma can affect the retroperitoneal plexus, causing dysfunction of the autonomic nervous system, leading to gastrointestinal and urinary tract motility and defecation dysfunction.

　　Local tenderness is found during abdominal examination. Sometimes, a mass or fullness can be felt in the abdomen, lateral abdomen, or腰部. Generally, there is no or only mild abdominal muscle tension. When the hematoma breaks into the abdominal cavity, or is accompanied by injury to abdominal visceral organs, intestinal paralysis may occur. If it is severe arterial hemorrhage, the mass can rapidly enlarge, even with pulsation. Bruises may appear around the skin near the waist, abdominal wall, and scrotum. When the hematoma breaks into the abdominal cavity, shock and peritoneal irritation signs often occur. Occasionally, reports of sciatic nerve involvement, with special manifestations of weakness of the quadriceps muscle and disappearance of patellar reflex, have been reported.

　　Avoid blunt trauma. Special precautions should be taken for the rupture and injury of the liver, spleen, kidney, adrenal glands, pancreas duodenum, and their blood vessels in the post-peritoneal space. This disease seriously affects the daily life of patients, so it should be actively prevented.

　　1. Routine X-ray examination or double-contrast angiography can reveal some lesions that can cause post-peritoneal cavity hemorrhage, such as fractures, abdominal aortic aneurysms, urinary or gastrointestinal diseases, unclear contours of the psoas muscle, and partial interruption of the marginal parts.

　　2. B-ultrasound can detect hematomas and abdominal aortic aneurysms, but the differentiation of hematomas from abscesses and other fluid accumulations (such as urine) often presents certain difficulties.

　　3. CT examination can clearly show the relationship between hemorrhage hematoma and other tissues. When enhanced scanning is performed, the attenuation value increases, which is evidence of active hemorrhage.

　　4. Angiography and isotope scanning can suggest the location of hemorrhage.

　　5. Under the guidance of B-ultrasound or CT, puncture aspiration is performed to confirm the diagnosis.

　　6. Laboratory tests: In the early stage, white blood cells may be slightly elevated or normal, while red blood cells and hemoglobin may decrease. In the later stage, white blood cells significantly increase, neutrophils increase. When there is pancreatic injury, serum amylase and urinary amylase increase. In cases of renal contusion and laceration, hematuria and proteinuria may occur.

　　Post-peritoneal space hemorrhage: What foods are good for the body

　　1. Eat more blood-boosting foods such as red dates, longan, and black beans.

　　2. To strengthen nutrition, it is recommended to choose easily digestible foods with sufficient calories, protein, and vitamins, such as congee, thin noodles, milk, soft rice, soy milk, eggs, lean meat, tofu, and soy products; foods rich in vitamins A, B, and C, such as fresh vegetables and fruits, etc.

　　3. Adequate nutritional substances should be provided for patients, such as lean meat, chicken, pigeon soup, etc.

　　Secondly, what foods should be avoided for retroperitoneal space hemorrhage

　　Avoid smoking, drinking, greasy, fried, moldy, and salted foods.

　　First, non-surgical treatment

　　Stable condition, no obvious symptoms or mild symptoms, or blood pressure and pulse are stable after fluid and blood transfusion, no surgery is needed. Treatment methods and principles:

　　1. Actively and reasonably apply antibiotics to prevent infection.

　　2. Rational use of hemostatic drugs, if anticoagulant therapy is the cause, anticoagulant drugs should be discontinued and blockers should be given.

　　3. For patients with large blood loss, blood transfusion should be given in a timely manner to effectively replenish blood volume and correct shock.

　　4. Patients with concurrent intestinal paralysis can be fasting, water, gastrointestinal decompression, or use traditional Chinese medicine, applying the method of purging and expelling, compound Dachengqi decoction added with alkali, and light gastric tube injection.

　　Second, surgical treatment

　　Surgical indications for this disease:

　　1. Pelvic fracture or abdominal injury causing persistent hemorrhage.

　　2. Hematoma spreading to the perineum and around the anal opening with an open penetrating wound.

　　3. There is confirmed or suspected injury to large and medium-sized blood vessels.

　　4. Patients with severe injury to abdominal internal solid organs or hollow organs.

　　5. Penetrating injuries with significant blood loss and peritoneal inflammation should be operated on early.

　　6. Retroperitoneal hemorrhage occurring during pregnancy or childbirth usually involves a large amount of bleeding. In addition to immediate blood transfusion, cesarean section is often required.

　　7. Post-peritoneal hematoma after penetrating injury should be treated with surgery; for blunt injury, conservative treatment should be given first, including close observation, bed rest, blood transfusion, and maintaining fluid balance by supplementing water and electrolytes. If blood pressure is still unstable and there is organ injury and rupture, surgery should be performed.

　　8. Spontaneous retroperitoneal hemorrhage (often occurs in kidney or adrenal gland diseases) usually requires surgical treatment. Retroperitoneal hematoma that has been encapsulated can be treated with simple drainage or surgical resection.